Worse with almost any wrist motion but worst with wrist extension and forearm supination (gymnastics coach – spotting consistently hurts her wrists), better with rest, avoidance of aggravating factors, positions

No improvements since onset

Medial Wrist Pain Case – Treatment Summary

The medial wrist pain case had pain with forearm pronation, “stretching the muscles,” that burned with wrist extension

I described how slacking an area that the brain is trying to protect is often a novel solution as it is already “tight” from a lock down the brain has been placing on it for months

Directional preference turned out to be wrist flexion with ulnar deviation – I tried this based on slacking the painful area, plus it being almost the opposite of the directional preference for a DeQuervains case

After loading this to end range about 30 times, wrist extension was pain free actively and passively and push ups were 90% improved

Homework was repeated wrist flexion and ulnar deviation with overpressure ten times hourly

Follow up 2 weeks later, his wrist is still coming along, but he has not been back to see me, he is able to do pushups now, with minimal to no pain, but is now limited by strength

Lateral Wrist Pain Case – Treatment Summary

For the lateral wrist pain case, pain was mostly with forearm supination, but all wrist motions hurt, with extension and grasping hurting the most

A similar explanation was given, except more emphasis was placed on slacking the tight muscles, and needing a novel solution

She was continuously trying to “stretch” out her tight thumb and wrist extensors with various positions of ulnar deviation

Her directional preference was wrist flexion and radial deviation, similar to my own wrist

After end range loading, and some light IASTM along her anterior and posterior forearm patterns, she reported at least 95% improvement

Homework was repeated wrist flexion with radial deviation with end range overpressure hourly normally, except when working out and spotting gymnasts, then 3-5 times every 5-10 minutes

When I followed up with her in the gym, a few days later, she was back to working out, spotting gymnasts and performing everything but pull ups pain free

Summary

Both cases had a directional preference that quickly reset
months of severe pain that was limiting many of their ADLs and exercise. Where
would I go next? If still not fully recovered, either make sure they are really
pressing to end range, show them how to tape the area using Kinesiotape for
more novel stimulus, and then make sure to add isometrics and/or eccentrics in
opposing ranges to the DP so that all motions can get to end range safely. The
medial wrist pain is slightly limited in push ups, and the lateral wrist pain
is slightly limited in pull ups. Perhaps they also just need a little bit more
graded exposure back to these activities before capacity exceeds training
instead of vice versa.

Interested in live cases where I apply this approach and integrate it with manual therapy and repeated motions? Check it out Modern Manual Therapy!

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